Sparling Alica S, Song Eunyoung, Klepin Heidi D, Foley Kristie L
1 Department of Economics, Davidson College, Davidson, NC 28035, USA ; 2 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA ; 3 Division of Hematology and Oncology, Department of Internal Medicine, Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA ; 4 Cancer Prevention and Control Program, Comprehensive Cancer Center, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
J Gastrointest Oncol. 2016 Jun;7(3):336-44. doi: 10.21037/jgo.2016.02.01.
Adjuvant chemotherapy for colon cancer has been linked to patient and provider characteristics but little is known about whether distance to chemotherapy providers constitutes an obstacle to chemotherapy.
A total of 1,184 Medicaid patients diagnosed with colon cancer in North Carolina in 1999-2002 comprised the sample. Data from the N.C. Central Cancer Registry, N.C. Medicaid Claims, American Hospital Directory and US Census were merged. Logistic regression models were used to estimate the association between chemotherapy receipt and the distance to nearest chemotherapy provider.
Compared to the referent group of SEER-staged II (local) cancer patients living less than 2 miles from the nearest chemotherapy provider, the odds of receiving chemotherapy fell as the distance to the nearest provider increased. The odds ratio (OR) for those living ≥5 to <15 miles away was 0.13 [95% confidence intervals (CI), 0.04-0.39], and OR for those living ≥15 miles away was 0.06 (95% CI, 0.01-0.52). Patients diagnosed with regional, SEER-staged III (regional) cancer were less likely to receive chemotherapy if they lived in rural areas more than 20 miles away from the nearest provider (OR =0.08; 95% CI, 0.01-0.72). However, we found no evidence of association between chemotherapy receipt and distance to the nearest provider for regional cancer patients living in urban areas and those living in rural areas within 20 miles from the nearest chemotherapy provider.
Distance to provider may be an obstacle to chemotherapy for some groups of low-income colon cancer patients. Relieving travel burdens of rural patients living far from providers may help Medicaid increase guideline-consistent adjuvant care for regional cancer patients.
结肠癌辅助化疗与患者及医疗服务提供者的特征有关，但距离化疗服务提供者的远近是否会成为化疗的障碍，目前所知甚少。
样本包括1999 - 2002年在北卡罗来纳州被诊断为结肠癌的1184名医疗补助患者。合并了北卡罗来纳州中央癌症登记处、北卡罗来纳州医疗补助索赔、美国医院名录和美国人口普查的数据。采用逻辑回归模型来估计接受化疗与距离最近化疗服务提供者的距离之间的关联。
与居住在距离最近化疗服务提供者不到2英里的SEER分期II期（局部）癌症患者的参照组相比，接受化疗的几率随着距离最近服务提供者的距离增加而降低。居住在≥5至<15英里外的患者的比值比（OR）为0.13[95%置信区间（CI），0.04 - 0.39]，居住在≥15英里外的患者的OR为0.06（95%CI，0.01 - 0.52）。被诊断为区域性、SEER分期III期（区域性）癌症的患者，如果居住在距离最近服务提供者超过20英里的农村地区，则接受化疗的可能性较小（OR = 0.08；95%CI，0.01 - 0.72）。然而，对于居住在城市地区的区域性癌症患者以及居住在距离最近化疗服务提供者20英里以内农村地区的患者，我们没有发现接受化疗与距离最近服务提供者的距离之间存在关联的证据。
对于某些低收入结肠癌患者群体，距离服务提供者的远近可能是化疗的障碍。减轻居住在远离服务提供者地区的农村患者的出行负担，可能有助于医疗补助计划增加对区域性癌症患者符合指南的辅助治疗。
